carboprost


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carboprost

 
a synthetic analogue of dinoprost, used as an oxytocic for termination of pregnancy and missed abortion, administered intramuscularly.

carboprost

(kar-bo-prost) ,

Hemabate

(trade name)

Classification

Therapeutic: abortifacients
Pharmacologic: oxytocics
Pregnancy Category: C

Indications

Induction of mid-trimester abortion.Treatment of postpartum hemorrhage that has not responded to conventional therapy.

Action

Causes uterine contractions by directly stimulating the myometrium.

Therapeutic effects

Expulsion of fetus.
Control of postpartum bleeding.

Pharmacokinetics

Absorption: Well absorbed following IM administration.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: Unknown.

Time/action profile (peak noted as mean abortion time)

ROUTEONSETPEAKDURATION
IMunknown16 hrunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Acute pelvic inflammatory disease; Active pulmonary, renal, or hepatic disease.
Use Cautiously in: Uterine scarring; Asthma; Hypotension; Hypertension; Cardiac disease; Adrenal disease; Anemia; Jaundice; Diabetes mellitus; Epilepsy.

Adverse Reactions/Side Effects

Central nervous system

  • dizziness
  • headache

Respiratory

  • wheezing

Gastrointestinal

  • diarrhea (most frequent)
  • nausea (most frequent)
  • vomiting (most frequent)
  • abdominal pain
  • cramps

Genitourinary

  • uterine rupture (life-threatening)

Dermatologic

  • flushing

Miscellaneous

  • fever (most frequent)
  • chills
  • shivering

Interactions

Drug-Drug interaction

Augments the effects of other oxytocic agents.

Route/Dosage

Test Dose

Intramuscular (Adults) 100 mcg.

Abortifacient

Intramuscular (Adults) 250 mcg every 1.5–3.5 hr depending upon uterine response; may be increased to 500 mcg if several doses of 250 mcg produce inadequate response (not to exceed 2 days of continuous therapy or total dose of 12 mg).

Refractory Postpartum Uterine Bleeding

Intramuscular (Adults) 250 mcg; may be repeated every 15–90 min (total dose not to exceed 2 mg).

Availability

Injection: 250 mcg/mL

Nursing implications

Nursing assessment

  • Monitor frequency, duration, and force of contractions and uterine resting tone. Notify physician or other health care professional if contractions are absent or last more than 1 min.
  • Monitor temperature, pulse, and BP periodically throughout course of therapy. Large dose may cause hypertension. Temperature elevation beginning 1 to 16 hr after initiation of therapy and lasting for several hours is not unusual.
  • Auscultate breath sounds. Wheezing and sensation of chest tightness may indicate hypersensitivity reaction.
  • Assess for nausea, vomiting, and diarrhea. Vomiting and diarrhea occur in approximately two-thirds of patients. Premedication with antiemetic and antidiarrheal is recommended.
  • Monitor amount and type of vaginal discharge. Notify physician or other health care professional immediately if symptoms of hemorrhage (increased bleeding, hypotension, pallor, tachycardia) occur.

Potential Nursing Diagnoses

Deficient knowledge, related to medication regimen (Patient/Family Teaching)

Implementation

  • Avoid contact with skin. Thoroughly wash skin immediately after spillage.
    • Opioid analgesic may be given for uterine cramping.
    • Store in refrigerator.
  • Intramuscular: Administer deep IM. Dose may be repeated every 1.5–3.5 hr. Rotate sites.

Patient/Family Teaching

  • Explain purpose of vaginal examinations (to assess for trauma to cervix).
    • Instruct patient to notify health care professional immediately if fever and chills, foul-smelling vaginal discharge, lower abdominal pain, or increased bleeding occurs.

Evaluation/Desired Outcomes

  • Complete abortion.
  • Control of postpartum or post-abortal hemorrhage.
References in periodicals archive ?
In cases of excess blood loss, clinicians request assistance from colleagues, endeavor to identify the cause of the bleeding, utilize additional uterotonics (methylergonovine, carboprost, misoprostol), perform uterine massage, warm the uterus, repair lacerations and replace blood products.
The researchers found that patients with asthma used carboprost less frequently than patients with no asthma (11.4 versus 18.0 percent) compared with intravenous labetalol, which was used more often among patients with a diagnosis of asthma than those without (18.5 versus 16.7 percent).
Tenders are invited for supply of Drugs and Dressings Nalidixic acid tab - each tab to contain: nalidixic acid 500 mg,flavoxate tab - each tab to contain: flavoxate hydrochloride 200 mg,carboprost inj - each ml to contain: carboprost 0.25mg,clotrimazole vaginal tab - each tab to contain: clotrimazole 200mg with applicator clotrimazole gel - each tube to contain:clotrimazole 2% w/w, dinoprostone gel- each pfsto contain:dinoprostone 0.5mg,estradiol 1 mg cream - each gm to contain: estradiol 1 mg
DALLAS -- A maternal death occurred at Columbia University Medical Center after a patient with asthma was given intravenous labetalol, prompting a study that found an elevated risk of status asthmaticus associated with intravenous labetalol administration but not with the uterotonic carboprost.
Need for additional uterotonics preoperatively did not occur in the carbetocin group, while two patients who received oxytocin needed additional carboprost (p = 0.2).
To treat uterine atony and intraoperative hemorrhage, the patient received 50 units of Oxytocin and 2 doses of Carboprost, 3 units of packed red blood cells (PRBCs), 1 unit of fresh frozen plasma (FFP), and 3,500 ml intravenous fluid.
The patient required doses of both carboprost tromethamine (Hemabate) and methylergometrine (Methergine) to increase uterine tone and control bleeding.
Case report: Life-threatening bronchospasm after intramuscular carboprost for postpartum haemorrhage.
Ergometrine 500mcg and carboprost trimethamine 250mcg were administered intramuscularly, as well as, misoprostol 800mg vaginally.
[9] Conservative surgical treatment under general anaesthesia includes suction curettage, Foley balloon tamponade and intracervical infiltration of Carboprost. [10] In a study undertaken by Kirk et al., [11] the success of conservative surgical treatment could be predicted by the diagnostic accuracy of initial ultrasound.
No se recomienda el uso de carboprost para el D tratamiento de las mujeres con hemorragia posparto.